HAI.ppt
Download as PPT, PDF0 likes373 views
This document provides information on preventing hospital acquired infections. It discusses key topics like universal precautions, hand hygiene, use of personal protective equipment, and disinfection of medical equipment to prevent the spread of infections. The document emphasizes the importance of knowledge, skills, and proper techniques in infection control and outlines best practices for preventing common infections like those related to urinary catheters, central lines, and ventilators.
HAI.ppt
- 2. Hospital Aquired Infection (HAI) Md. Ahasan Habib RN
- 3. Learning Objectives 1. Recognize patient safety as an important nursing responsibility in global health care systems. 2. Apply required knowledge in preventing and/or minimizing infection. 3. Perform appropriate behaviors required to prevent health care associated infections. 4. Demonstrate required competence to provide patients with safe care.
- 4. Introduction to Patient Safety: Definition Patient safety is a discipline in the health care sector that applies safety science methods toward the goal of achieving a trustworthy system of health care delivery. Patient safety is also an attribute of health care systems; it minimizes the incidence and impact of, and maximizes recovery from, adverse events (Emanuel et al., 2008) .
- 5. Introduction to Patient Safety: Goal Prevent and/or minimize the adverse events and eliminate preventable harm in health care. All health care professionals including nurses are responsible for ensuring patient safety
- 6. Hospital Aquired Infection (HAI) According to WHO: HAI is also called “nosocomial”. HAI is defined as: an infection acquired in hospital by a patient who was admitted for a reason other than that infection. an infection occurring in a patient in a hospital or other health-care facility in whom the infection was not present or incubating at the time of admission.
- 7. Impacts of Hospital Aquired Infection (HAI) HAI can: Increase patients’ suffering. Lead to permanent disability. Lead to death. Prolong hospital stay. Increase need for a higher level of care. Increase the costs to patients and hospitals.
- 8. Preventing infections Requires health care providers who have: Knowledge of common infections and their vectors An attitude of cooperation and commitment Skills necessary to provide safe care
- 9. Required Knowledge Knowledge of the extent of the problem; Knowledge of the main causes, modes of transmission, and types of infections.
- 10. Required Attitudes Being an effective team player. Commitment to preventing HAIs
- 11. Required Skills Apply universal precautions* Use personal protection methods Know what to do if exposed Encourage others to use universal precautions Report breaks in technique that increase patient risks Observe patients for signs and symptoms of infection
- 12. One more important thing! Protect Yourself Be sure you have been immunized against Hepatitis B since it is very easy to transmit!
- 13. Main Sources of Infection Person to person via hands of health-care providers, patients, and visitors Personal clothing and equipment (e.g. Stethoscopes, flashlights etc.) Environmental contamination Airborne transmission Hospital staff who are carriers Rare common-source outbreaks
- 14. Main Routes for infections Urinary tract infections (UTI) Catheter-associated UTIs are the most frequent, accounting for about 35% of all HAI. Surgical Site Infections (SSI): about 20% of all HAI Bloodstream Infections (BSI) associated with the use of an intravascular device: about 15% of all HAI Ventilator Associated Pneumonia (VAP): about15% of HAI
- 15. PREVENTION OF CR-UTI The UTI following catherization are the most common HAIs accounting for approximately 30-40% of all NCIs. There for it is important that catheterization should be avoided if possible, and only be used when there is clear medical indication Catheter should be removed as early as possible preferably with in 10 days Indications for urinary catheterization- Closely monitor urinary output (haemodynamic monitoring), bladder outlet obstruction, lack of bladder control, signs that kidney’s are not working well, the patient is severely ill etc
- 16. Considerations prior to catheterization 1.Urethral catheterization should be considered as a minor surgical procedure 2.UC must be inserted using aseptic technique and sterile equipments 3.Before the procedure, efficient and effective cleaning should be undertaken 4.Aseptic technique should be maintained thru out the procedure 5.Only closed urinary drainage system should be used 6.Prior to insertion procedure must be explained to the patient
- 17. Catheter selection Choice of catheter material will depend on the clinical experience and anticipated duration of catheterization Latex catheters are the least expensive but Silicone catheters are comfortable and better choice for long term use. Catheter size—Larger diameter block the urethral gland and put pressure on the urethral mucosa and it cause ischemic necrosis especially in males In general smaller diameter with 10 ml balloon allows free flow of urine. Smallest catheter cause leakage , and urological patients may need large diameter catheter but it must be used by the advise of Urologist
- 18. Maintenance of catheter After insertion ,regular inspection of the catheter and drainage system must be attended and documented Meatal care—cleansing should be performed at intervals appropriate for keeping meatus free from contamination. Cleansing with antiseptic solutions are necessary to maintain hygiene If faecal contamination occurs perineum must be cleaned and catheter should be changed with out delay
- 19. Equipments required for catheterization 1.Sterile tray containing sponge holding forceps, galipot, gauze, and cut sheet 2 . Sterile gloves, Betadine solution, distilled water, 10 cc syringe.2, lignocaine jell 2% 3.Sterile catheter as per requirement 4.Sterile Drainage bag, 5.Micropre
- 20. Procedure -catherization 1.All equipments used must be sterile 2.Hands must be washed thoroughly with an antiseptic preparation 3.Sterile gloves must be worn and no-touch aseptic technique must be used 4 .Peri urethral area must be cleaned thoroughly 5.Use cut sheet to make the field sterile 6.Single use sachet of sterile water soluble lubricant 1- 2% Lignocaine gel should be used on a catheter prior to insertion to reduce pain, friction and trauma
- 21. Gently insert the catheter and advance it by holding the inner sterile surfaces Inflate the balloon by instilling the manufacture’s recommended amount of sterile water Connect catheter to a sterile closed drainage system Attach the drainage bag with bed frame below the level of the bed. The bag and tubing's must all the time below the level of the bladder Secure catheter to patient’s thigh or abdomen to prevent movement and urethral meatal ulceration Hands should be washed after gloves are removed Document the procedure (date & time ,and procedure done by whom ) Procedure –catherization cont…
- 22. Specimen collection Obtain a urine sample from a sampling port. Do not disconnect the drainage bag to obtain sample. Sampling port must be disinfected by wiping with hexisol then sample may be aspirated using sterile small bore needle and syringe and transferred in to a sterile container.
- 23. Removal of catheter Optimal time limit for replacing catheter depends on individual circumstances Use of anti microbial agents— Administration of antibiotic at the time of insertion may provide early benefit to prevent CR- UTI Staff training—Ensure that health care personnel are trained and competent to carry out urethral catheterization
- 24. IV lines are an integral part of patient care. They provide a route for administering fluids, blood products, nutrients, iv medications, for obtaining blood specimens, etc Prevention of Central line Related – Blood Stream Infection (BSI) Indications of CVC
- 25. Selection of Insertion site Select the insertion site and technique with lowest risk of complications. C/L should not be inserted in to an area of inflammation or infection Peripheral IV lines –upper extremity site in preference to lower extremity in adults CVC—subclavian rather than jugular or femoral site unless contra indicated ( eg Porta-A cath ) should be used for patients who require long term use ( 30days )
- 26. Procedure of insertion CVC Collect all necessary equipments Wash hands and use antiseptic hand rub Sterile gown, gloves and mask should be worn, use large sterile drape to cover the area. Disinfect insertion site by chlorhexidine for at least 1mt to prior insertion Insert CVC maintaining no touch technique thru out procedure. position of the CVP line must be checked by x’ray
- 27. Procedure cont’d Leave the site clean and dry after insertion Secure the line with tegaderm and dressing Label the site date and time and document in patients record Connect the iv administration set Dispose sharps Wash and dry hands IV injection ports should be disinfected with alcohol swab before administering injections
- 28. Catheter site dressing Sterile dressing should be used to cover the catheter site either a gauze or transparent dressing should be used Sterile gloves should be used when changing dressing of CVC The catheter site dressing should be replaced when the dressing become damp, loosened, soiled, or when inspection of the site is necessary The dressing should be changed on a regular basis depending on the individual circumstances
- 29. VENTILATOR ASSOCIATED PNEUMONIA (VAP)—PREVENTION VAP-Is an important cause of morbidity and mortality in ventilated pts The measures to prevent VAP classified as Pharmacological and non pharmacological
- 30. Non Pharmacological measures for preventing VAP Monitoring endotracheal tube cuff pressure Optimum pressure high enough to avoid gas escape and the leakage The cuff pressure should be persistently maintained at 20-30cmH2O Subglotic secretions drainage is reccomended in pts expected to require more than 72 hrs of ventilation
- 31. Cont… Avoiding delay in extubation Remove ET from pts as soon as the clinical situation allows, the duration of intubations can be reduced by protocols to improve the use of sedation and to accelerate weaning Avoiding re- intubations. It can be reduced by avoiding accidental removal of the ETT, and planed extubations
- 32. Sterilization & Disinfection Respiratory devices such as nebulizers, resuscitation bags, Respirometers, should be disinfected or sterilized for use in different patients to avoid cross contamination Barrier measures—colonization of the hands of the health care worker increases the risk of NCI by cross contamination with procedures such as suctioning, manipulation of ventilatory circuits and bronchoscopy It can be reduced by using adequate barrier measures such as hand washing, use of gloves , mask and gowns.
- 33. Semi recumbent position 30-45 degree Some studies have found the semirecumbent position to be associated with lower level of VAP incidence than in supine position The position of the upper body of the patient should not be less than 10 degree at any time including basic care or transport.
- 34. Oral cleaning and decontamination Recommend the use of chlorhexidine rinse and mechanical cleaning of the oral cavity. Stress ulcer prophylaxis Avoidance of sedation and paralytic agents
- 35. SURGICAL SITE INFECTION Criteria for defining SSIs
- 38. Risk and prevention Wound classification Patient factors Environmental factor Clean Diabetes Preoperative antiseptic showering Clean- contaminated Obesity Preoperative hair removal Contaminated Nicotine use Patient skin preparation Dirty Steroid use Preoperative hand/forearm antisepsis Malnutrition Antimicrobial prophylaxis Hospital stay Nares colonization with S. aureus Transfusion
- 39. Four Ways to Prevent HAI 1. Maintain cleanliness of the hospital. 2. Personal attention to handwashing before and after every contact with a patient or object. 3. Use personal protective equipment whenever indicated. 4. Use and dispose of sharps safely.
- 40. Prevention in Hospitals and Clinics Studies show infections are minimized when hospitals/clinics: Are visibly clean; Use increased levels of cleaning during outbreaks; Use hypochlorite and detergents during outbreaks.
- 41. Prevention through Handwashing Handwashing: the single most important intervention before and after patient contact. Required knowledge and skills: How to clean hands Rationale for choice of clean hand practice Techniques for hand hygiene Protect hands from contaminants Promote adherence to hand hygiene guidelines
- 42. Five moments for hand hygiene Before patient contact Before an aseptic task After body fluid exposure even if wearing gloves! After patient contact After contact with patient surroundings
- 43. Your 5 moments for HAND HYGIENE
- 44. How to Clean Hands Remove all wrist and hand jewelry. Cover cuts and abrasions with waterproof dressings. Keep fingernails short, clean, and free from nail polish.
- 48. Personal Protective Equipment Gloves, aprons, gowns, eye protection, and face masks Health care workers should wear a face mask, eye protection and a gown if there is the potential for blood or other bodily fluids to splash.
- 49. Personal protective equipment 2 Masks should be worn if an airborne infection is suspected or confirmed to protect an immune compromised patient.
- 50. Gloves Gloves must be worn for: all invasive procedures contact with sterile sites contact with non-intact skin or mucous membranes all activities assessed as having a risk of exposure to blood, bodily fluids, secretions and excretions, and handling sharps or contaminated instruments. Hands should be washed before and after gloving
- 51. Safe Use and Disposal of Sharps Keep handling to a minimum Do not recap needles; bend or break after use Discard each needle into a sharps container at the point of use Do not overload a bin if it is full Do not leave a sharp bin in the reach of children
- 52. Required Performance Nursing students need to: apply universal precautions be immunized against Hepatitis B use personal protection methods know what to do if exposed encourage others to use universal precautions
- 53. Act to Minimize Spread of Infection-1 Before contact with each and every patient: clean hands before touching a patient clean hands before an aseptic task
- 54. Act to Minimize Spread of Infection-2 After contact with each and every patient: clean hands after any risk of exposure to body fluids clean hands after actual patient contact clean hands after contact with patient surroundings
- 55. Encourage Others to Participate in Infection Control Students may routinely observe staff who: apply inadequate technique in handwashing fail to wash hands routinely violate correct infection control procedures
- 56. References World Health Organization. (2010). WHO Patient Safety Curriculum Guide for Medical Schools. World Health Organization. (2010). Topic 1: What is patient safety? World Health Organization. (2010). Topic 9: Minimizing infection through improved infection control. Emanuel, L., Berwick, D., Conway, J., Combes, J., Hatlie, M., Leape, L., Reason, J., Schyve, P., Vincent, C., & Walton, M. (2008). What exactly is patient safety? Advances in Patient Safety, Vol. 1: Assessment. Retrieved from http://www.ncbi.nlm.nih.gov/bookshelf/br.fcgi?book=aps2v1&part=ad vances-emanuel-berwick_110 Burke, J. P. (2003). Infection control — A problem for patient safety. The New England Journal of Medicine, 348, p. 651-656.
- 57. Quiz 1 Q. How many moments for HAND HYGIENE?
- 58. Q. When we will considered an infection as SSI? Quiz 2
- 59. Q. Elaboration of VAP? Quiz 3
- 61. Thanks for your attention!!!
Editor's Notes
- #4: After completion of this unit, the learners will be able to: Recognize patient safety as an important nursing responsibility in global health care systems. Apply required knowledge in preventing and/or minimizing infection. Perform appropriate behaviors required to prevent health care associated infections. Demonstrate required competence to provide patients with safe care.
- #5: According to Institute of Medicine, safety is defined as “freedom of accidental injury”. Reference: Emanuel, L., Berwick, D., Conway, J., Combes, J., Hatlie, M., Leape, L., Reason, J., Schyve, P., Vincent, C., & Walton, M. (2008). What exactly is patient safety? Advances in Patient Safety, Vol. 1: Assessment. Retrieved from http://www.ncbi.nlm.nih.gov/bookshelf/br.fcgi?book=aps2v1&part=advances-emanuel-berwick_110
- #7: WHO [12] defines a health care-associated infection (also called “nosocomial”) as: An infection acquired in hospital by a patient who was admitted for a reason other than that infection. An infection occurring in a patient in a hospital or other health-care facility in whom the infection was not present or incubating at the time of admission. This includes infections acquired in the hospital but appearing after discharge, and also occupational infections among staff of the facility.
- #8: In the United States, 1 out of every 136 hospital patients becomes seriously ill as a result of acquiring an infection in hospital; this is equivalent to two million cases and about 80 000 deaths a year. In England, more than 100 000 cases of health care-associated infection lead to over 5000 deaths directly attributed to infection each year. In Mexico, an estimated 450 000 cases of health care-associated infection cause 32 deaths per 100 000 inhabitants each year. Health care-associated infections in England are estimated to cost £1 billion a year. In the United States, the estimate is between US$ 4.5 billion and US$ 5.7 billion per year. In Mexico, the annual cost approaches US$ 1.5 billion.
- #10: What students need to know (knowledge requirements): • know the extent of the problem; • know the main causes and types of infections.
- #12: Universal precautions: "Universal precautions," as defined by CDC, are a set of precautions designed to prevent transmission of human immunodeficiency virus (HIV), hepatitis B virus (HBV), and other bloodborne pathogens when providing first aid or health care. Under universal precautions, blood and certain body fluids of all patients are considered potentially infectious for HIV, HBV and other bloodborne pathogens. Retrieved from CDC web site http://www.cdc.gov/ncidod/dhqp/bp_universal_precautions.html
- #14: Health care-associated infections Infections are caused by bacteria, fungi or viruses entering the body through one or more of the following routes. • person-person via hands of health-care providers patients and visitors; • personal equipment (e.g. stethoscopes, computers) and clothing; • environmental contamination; • airborne transmission; • carriers on the hospital staff; • rare common-source outbreaks. Epidemiological evidence suggests that multidrug-resistant organisms are carried from person-to-person by health-care professionals. Carriers are individuals who harbor disease organisms in their body without visible symptoms and may pass the infection to another person. It is possible to carry an organism without being aware of it for example, Typhoid Mary a woman who carried the typhoid bacillus and unknowingly started an epidemic in the US in the 1880s . Outbreak is a term used in epidemiology to describe an occurrence of disease greater than would otherwise be expected in a particular time and place. It may be small and localized group or impact upon thousands of people across an entire continent. Two linked cases of a rare infectious disease may be sufficient to constitute an outbreak. Outbreaks may also refer to epidemics, which affect a region in a country or a group of countries, or pandemics, which describe global disease outbreaks. Common source outbreak Some diseases arise from a single definable source, such as a common water supply. The basic idea is that common source outbreaks are not propagated from individual-to-individual (e.g., person-to-person). Instead, sick individuals typically are propagation dead ends. Yet the disease continues to be endemic and perhaps epidemic as a consequence of contact with some typically geographically well-defined disease reservoir.
- #15: The following four types of infections account for more than 80% of all health care-associated infections: • urinary tract infections usually associated with catheters: - catheter-associated urinary tract infections are the most frequent, accounting for about 35% health care-associated infections; • surgical infections: - these are second in frequency, about 20%; • bloodstream infections associated with the use of an intravascular device: - about 15%; • pneumonia associated with ventilators: - about 15%.
- #40: Students should approach every situation as having the potential to infect a patient or a health-care worker or themselves. Infections are preventable when health-care workers use the right techniques and remain on the look out for unclean and unsafe situations.
- #42: Handwashing today is the single most important intervention before and after patient contact. Every health-care worker is required to act responsibly and without fail to apply the techniques for handwashing at every patient encounter. They also should advise patients and families of the importance of handwashing and give them permission to remind the staff. Decontamination refers to the process for physical removal of blood, bodily fluids and the removal or destruction of micro-organisms from the hands.
- #45: • limited studies available to test the technique of hand decontamination; • methods based on expert opinion: - before clinical shift begins remove all wrist and hand jewelry; - cuts and abrasions covered with waterproof dressings; - fingernails kept short clean and free from nail polish.
- #46: Soap solution must have contact with whole surface area of hands—vigorous rubbing of hands for 10–15 seconds (especially tips of fingers, thumbs and areas between fingers). A link to drawings showing the procedure - Effective Handwashing Technique
- #47: Links to drawings and directions for this procedure - How to use waterless handrub Click on to start video (link to the file)
- #49: Personal protective equipment includes the use of gowns, gloves, aprons, eye protection and face masks. The use of these equipment is usually based on assessment of the risk of micro-organism transmission to the patient or to the carer as well as the risk of contamination of the health-care practitioner’s clothing and skin by the patient’s blood, bodily fluids, secretions or excretions.
- #51: 1. Gloves are now an everyday part of clinical practice. There are two main indicators for wearing gloves in the clinical setting: • to protect the hands from contamination with organic matter and micro-organisms; • to reduce the risk of transmitting microorganisms to both patients and staff. 2. Even if a student is required to wear gloves this does not replace the need for cleaning one’s hands. 3. Gloves must be worn for: - all invasive procedures; - contact with sterile sites; - contact with non-intact skin or mucous membranes; - all activities assessed as having a risk of exposure to blood, bodily fluids, secretions and excretions, and handling sharps or contaminated instruments. 4. Gloves should be worn only once and should be put on immediately before the care activity, removed immediately afterwards and changed between patients and pisodes of care; 5. Gloves must be disposed of as clinical waste and hands must be decontaminated by washing appropriately.
- #52: Students should be aware of the significant problem for health-care workers caused by needle stick injuries, which are as prevalent as injuries from falls and handling and exposure to hazardous substances.
- #53: Nursing students need to make every effort to minimize the spread of infection and to encourage patients and other health-care workers to actively engage in practices that minimize the spread of infection in the community, the hospitals, and the clinics.
- #54: Before contact with each and every patient a student should clean their hands before touching a patient. This is important to protect the patient against harmful micro-organisms carried on the hands. Students may have been travelling on a bus immediately before entering the hospital and the ward where they intend to take a history from a patient. In doing so they may shake the hand of the patient or comfort the patient as a humane gesture. They may also be requested to assist a patient to move from the bed to a chair, or to a sitting area for more privacy. They might be required to perform a physical examination, take the pulse of the patient or blood pressure and abdominal palpation. A student should clean hands before an aseptic task. It is essential that students clean their hands immediately before any aseptic task. This is necessary to protect the patient against harmful micro-organisms, including the patient’s own micro-organisms, entering his or her body. Students must protect against transmission through contact with mucous membrane: oral/dental care, giving eye drops, secretion aspiration. Often students will be treating patients who have open wounds and any contact with non-intact skin: skin lesion care, wound dressing, any type of injection is an opportunity for transmission. Medical devices are well known for harbouring potentially harmful micro-organisms and contact with devices such as catheter insertion, opening a vascular access system or a draining system must be done with careful preparation. Students should also be diligent in preparation of food, medications and dressing sets.
- #55: After contact with each and every patient a student should clean hands after any risk of exposure to body fluids. Students should habitually clean their hands immediately after an exposure risk to body fluids and after glove removal. Cases of transmission have been to know to occur even with gloving. This is essential to limit the opportunity of the student receiving an infection. It is also necessary to maintain a safe health-care environment. Students should wash hands after actual patient contact. All students should clean their hands after touching a patient and his or her immediate surroundings. This should be done using one of the methods available to the clinic or hospital immediately after the patient contact is over. This is because in busy environments there are many distractions and busy people tend to rush onto the next job or patient. Many people forget in the rush to wash their hands. Forgetting to wash hands can lead to the student getting an infection and increasing the chances of the microorganisms spreading throughout the environment. Saying goodbye to the patient by shaking a hand or touching a shoulder provides opportunities for micro-organisms to be transferred to the student and vice versa. Activities in addition to those mentioned above that involve direct physical contact include helping a patient to move around, to get washed or to give a massage, which are known routes for micro-organisms spreading to others. Students performing clinical examination such as taking pulse, blood pressure, chest auscultation and abdominal palpation are all opportunities for cross-infection. Students must handwash after contact with patient surroundings Micro-organisms are also known to survive on inanimate objects. So it is important to clean one’s hands after touching any object or furniture in the patient’s immediate surroundings when leaving them, even without touching the patient. Students may find themselves helping other staff and change bed linen, adjust perfusion speed, monitor an alarm, hold a bed rail or make room on a side bed table for a patient.
- #56: When this occurs students should maintain correct handwashing techniques and if appropriate have a discussion about the techniques used in the hospital or clinic and the reasons for the variation. However, in many cultures this may not be appropriate. How a student deals with this situation will depend on the relationship of the student to the person who fails to wash their hands, the culture of the hospital and the culture of the society.
- #57: http://www.ncbi.nlm.nih.gov/bookshelf/br.fcgi?book=aps2v1&part=advances-emanuel-berwick_110